Huijbregts Henricus J T A M, Bots Michiel L, Moll Frans L, Blankestijn Peter J
Department of Nephrology, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Room F03.223, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Nephrol Dial Transplant. 2007 Sep;22(9):2595-600. doi: 10.1093/ndt/gfm221. Epub 2007 Apr 23.
In the Netherlands, arteriovenous fistulas (AVFs) are used in 60-65% of the haemodialysis patients and this compares poorly with the European average. A multicentre guidelines implementation programme, CIMINO, was initiated aiming at increasing the use of AVFs.
Physicians and dialysis staff in 11 participating centres (N=1092 vascular accesses) were strongly and repeatedly advised to adhere to current guidelines with extra attention for pre-operative duplex examination and salvaging of failing and failed fistulae. Specially appointed access nurses prospectively registered all created vascular accesses using an internet-linked database. In 22 other centres (N=1566 accesses), the CIMINO programme was not offered and they were considered the control group.
On 1 January 2006, average follow-up time of the CIMINO group and the control group were 13.3 months and 34.1 months, respectively. A total of 598 new vascular accesses (77% AVFs) were created in the CIMINO group. Prevalent AVF use increased from 58.5% (range: 31-79%) to 62.7% (range: 45-83%) in the CIMINO group and from 65.5% (range: 31-91%) to 67.3% (range: 42-91%) in the control group. The increase in AVF use per year was significantly quicker than in the control group (P<0.05). Use of untunnelled catheters decreased whereas that of tunnelled catheters increased.
This initiative shows that a multicentre guidelines implementation programme results in an accelerated increase of AVF use in comparison with a time control group. These data suggest that the choice of access placement depends predominantly on centre-specific factors.
在荷兰，60% - 65%的血液透析患者使用动静脉内瘘（AVF），这一比例与欧洲平均水平相比很低。启动了一项多中心指南实施计划CIMINO，旨在增加AVF的使用。
11个参与中心的医生和透析工作人员（N = 1092例血管通路）被反复强烈建议遵守现行指南，尤其要重视术前双功超声检查以及对功能不良和失功内瘘的挽救。特别指定的通路护士使用互联网连接数据库前瞻性地记录所有建立的血管通路。在另外22个中心（N = 1566例通路），未实施CIMINO计划，它们被视为对照组。
2006年1月1日，CIMINO组和对照组的平均随访时间分别为13.3个月和34.1个月。CIMINO组共建立了598例新的血管通路（77%为AVF）。CIMINO组中AVF的使用率从58.5%（范围：31% - 79%）增至62.7%（范围：45% - 83%），对照组中则从65.5%（范围：31% - 91%）增至67.3%（范围：42% - 91%）。每年AVF使用率的增长明显快于对照组（P < 0.05）。非隧道式导管的使用减少，而隧道式导管的使用增加。
该倡议表明，与时间对照组相比，多中心指南实施计划可加速AVF使用率的提高。这些数据表明，通路放置的选择主要取决于特定中心的因素。
